Application Period: April 1 May 31
Directions: Please complete each item by typing directly into the fields or neatly printing on a hardcopy, and
submit this Admission Application Checklist with all required documents to a Health Sciences Counselor via
UH File Drop. We will not be accepting in-person applications during this application period.
To use file drop follow the directions below:
1. Scan application and all supporting documents
a. If you do not have access to a scanner, use a free smartphone app like Scannable or Scanner Pro
or Cam Scanner. Save your application and all supporting documents in PDF format.
2. From any web browser, go to https://www.hawaii.edu/filedrop
3. Log in as a UH User or Non-UH user (Non-UH Users will be sent a verification email, click on the link
in the email)
a. In the recipient field, type: hlthsci@hawaii.edu
b. Click in the drop down menu in the expiration timer, change it to 14 days
c. In the “Optional Message” field, enter FULL NAME and the PROGRAM you are applying to
d. After you’ve completed the Recipient field, extended the expiration timer, typed in the Optional
Message, click Proceed.
e. Click the Choose File button to browse for your application and supporting documents.
i. If you upload your docuemnts in different files (i.e. application, transcripts, etc), please
write a description of the file in the Description box.
f. Click the Start Upload button.
g. You will be redirected to a confirmation page with the link to your uploaded file. You’re
4. Once your application is reviewed, you will receive a confirmation email to indicate that your
application is complete or that you are missing items. If you are missing items, you must have a
complete application submitted by the application deadline.
Please contact us at hlthsci@hawaii.edu or 808-734-9224 if you have any questions or need assistance with
these temporary application submission procedures.
Health Sciences Department
Kapi`olani Community College
Admission Application Checklist
Application Period: April 1 May 31
Directions: Please complete each item carefully typewritten or neatly printed, and submit this Admission Application
Checklist and all required documents to a Health Sciences Counselor during walk-in counseling hours. If the application
deadline falls on a weekend or recognized holiday, applications will be accepted on the following business day. Only
this completed program Admission Application including supplemental documentation submitted to the Health
Career Counseling Center (Kauila 106) by the appropriate deadline will be accepted for processing. Applications
must be submitted in person during walk-in counseling only.
Name: UH Number/Username
Last Name First Name M.I.
Street / POB City State Zip Code
Cell Home
UH SYSTEM Email Address:
List other name(s) used on documents:
(Notify the KCC Kekaulike Information & Service Center regarding other names used on college documents.)
1. Attend a mandatory PTA Program Information Session within one year prior to the close of the
application period. For more information visit www.kapiolani.hawaii.edu or pick up an Information Session
schedule from Kauila 122 or Kauila 106, Monday Friday during regular business hours.
Date Attended:__________________________ (Month / Day / Year)
2. Complete the online UH System Application if you are not currently enrolled at any UH System institution
during the semester you submit your application. (http://apply.hawaii.edu)
3. Complete prerequisite courses with a “C” grade or higher by the application deadline.
4. Please indicate any previous degree(s) earned (5 points awared for completion of any degree)
Associate Degree Bachelor’s Degree Master’s Degree Doctoral Degree
5. College transcripts for courses completed within the University of Hawai‘i System. Print out student copy
of unofficial transcripts for all course work WITHIN the UH System and highlight all prerequisite/qualification
courses. UH system transcripts are downloadable from the UH Portal (myuh.hawaii.edu
6. College transcripts for courses completed outside of the University of Hawai‘i System.
If transferring courses from institutions outside the UH System, please list the institution and when your
transcript was requested:
• Institution: Transcript Request Date:
• Institution: Transcript Request Date:
• Institution: Transcript Request Date:
Health Sciences Department
Kapi`olani Community College
Admission Application Checklist
My external transcripts have been evaluated by KCC. Submit your transfer course report from
STAR accessible via the UH Portal (myuh.hawaii.edu).
My external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center, complete
Online request for Transcript Evaluation. To complete this form, you must log in with your UH
Email account. Complete
this form at: http://go.hawaii.edu/oxG
7. Clinical Observation Hours. Original reference sheet of the minimum 20 hours of volunteer or work or
experience in a Physical Therapy Clinic must be attached to this application. Observation hours are valid for
two years from the date of completion of observation experience.
8. Letter of Recommendation: Applicants must submit a letter of recommendation from an individual related to
your work, volunteer, and/or educational experiences in the health pathway. Letters must include the
recommender’s signature, contact phone number and/or email. Letters of recommendation must be received by
the application deadline. Due to the COVID19 pandemic, letters may be emailed directly to the PTA Program
Director Bennett Zazzera at bzazzera@hawaii.edu The letter of recommendation is worth a total of 10 points.
9. My Plan Initiative.” Complete self assessments for your program/career pathway.
I certify that the answers and responses provided for all of the items on this Admissions Application are true to the best of my
knowledge. I understand that providing incorrect or false information will subject me to the requirements and/or discipline
measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program of
application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change
my major and home institution if I am accepted into the PTA program. I understand that if I am not accepted into the PTA
program, my home institution and major will not change.
“Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not satisfying
academic program requirements. It is the responsibility of the student to satisfactorily complete any background
checks and drug testing that may be required by the affiliated health care facility to which he/she is assigned for
clinical practice in accordance with procedures and timelines as prescribed by that affiliated health care facility.”
I have read and understand the notification that a background check and drug test may be required for entry into clinical
practice. I also understand that clinical practice is required for completion of this program. ________ (please initial)
I understand that priority selection is given to Hawai‘i State residents for tuition purposes and that non-residents will be
considered after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
I have completed, attached, and submitted all necessary application documents and prerequisites at the time of this application.
I understand the selection is based on a Best Qualified, First Accepted basis.
Print Name ____________________________ Signature ________________________ Date_____________
Health Sciences Department
EXAMPLE of how to complete the application:
These are the requirements
Tell us what class you took to meet each requirement
Circle Points
Term of
Grade Points
ENG 100 Composition I (3)Composition I
ENG 101 3.0 Fall 2009
15 5 0
Health Sciences Department
Qualification is based on a rating system for grades of completed prerequisite courses and observation reference points.
Selection is based on total qualifying scores in rank order from the highest until admission quota is met.
Students must circle the points based on the grade achieved for that course.
Prerequisite Course OR
Equivalent course title from
another institution
Term of
Institution Credits Grade
ENG 100 (3)
Composition I
5 3 1
MATH 103 (3) or Higher
Fundamentals of College Algebra
OR higher.
5 3 1
*PHYL 141 (3)
Human Anatomy & Physiology I
10 6 2
* PHYL 141L (1)
Human Anatomy & Physiology I
5 3 1
* PHYL 142 (3)
Human Anatomy & Physiology II
10 6 2
* PHYL 142L (1)
Human Anatomy & Physiology II
5 3 1
SP 181 (3)
Interpersonal Communication
5 3 1
FAMR 230 (3)
Human Growth & Development
5 3 1
A.S. Arts & Humanities Course (3)
(100 Level or higher)
5 3 1
HLTH 125 (1)
Survey of Medical Terminology
5 3 1
HLTH 120 (1)
Introduction to Health Professions
5 3 1
*HLTH 290 (2)
10 6 2
*HLTH 290L (1)
Kinesiology Lab
5 3 1
PTA 101 (1)
Professional Issues I: Intro to Physical
5 3 1
*Courses only valid for 5 years
Kapi‘olani Community College, Health Sciences and Emergency Medical Services Departments
4303 Diamond Head Road, Kauila 106 Honolulu, Hawai’i 96816-4421 Telephone: (808) 734-9224
Website: www.kapiolani.hawaii.edu
An Equal Opportunity/Affirmative Action Institution
Application Summary: For office use only
Date R
eceived: _____________________ KCC GPA: _______________
esident: Y N Counselor’s Initials: _________________ Application Complete: _____________
Health Sciences Department
Prerequsite Course Score: _______/85
Reference Score: _______/10
Degree Completion: _______/5
TOTAL Application Score: _______/100
The My Plan Self-Assessment is a counseling tool for prospective healthcare majors to help you identify and better understand
your career pathway, strengths, and areas of focus. Working in healthcare requires a combination of academic and professional
knowledge and skills and a commitment to public service. As you plan, find ways to make your strengths shine and to improve your
weaker areas. Please complete this self-assessment by marking the appropriate boxes. All response are voluntary. This assessment
does not affect your eligibility for admission. This assessment and is used for all ten Health Academic programs, therefore there may
be some statements that do not apply to your specific program.
Knowledge of the Profession
ed career goals in my health pathway
Identified career alternatives in my health pathway
Relevant experience by volunteer experiences
Relevant experience by servicing learning experiences
Relevant public serviceby paid work experiences
Understand “professional qualities” of health pathway(s)
Understanding of current healthcare issues
Comfort with bodily fluids or personal patient care
Comfort with illness
Comfort with injury
Comfort with death
Comfort with physical contact with people
Ability to multitask and adapt to change
Ability to accept constructive feedback
Ability to handle occupational crises, challenges or problems
Ability to move forward to achieve the goals and outcomes
Ability to follow safety guidelines and standards of practice
Personal Characteristics
ate commitment to public service
Demonstrate empathy/altruism
Demonstrate moral/ethical integrity
Demonstrate emotional maturity
Demonstrate good interpersonal relationships
Accept responsibility
Ability to work independently to achieve the goal/task
Collaborate and teamwork to achieve the goal/task
Accept and demonstrate leadership
Be dedicated/hard-working healthcare practitioner
Committed to life-long learning
Kapi`olani Community College
Self Assessment
Health Sciences Department
Academic Strength
+Completed prerequisites of health program of study
+Completed support courses of health program of study
Achieved minimum cumulative GPA for program entry
Achieved prerequisite course GPA for your program entry
Effective verbal and nonverbal communication skills
Ability to utilize technology effectively for learning
Established Support Systems to Succeed in
Health Pathway Program
Established support for transportation to externships
Established support for financial assistance prior to entry
Established support for nonacademic responsibilities
Established support for personal and time management skills
Established support for continuous professional learning
Established opportunities to balance personal, family, & school
Established support for campus and community resources
+As required for
program entry and graduation or meet other requirements as directed for program admissions.
An Equal Op
portunity/Affirmative Action Institution
Kapi`olani Community College
The University of Hawai‘i does not discriminate on the basis of race, sex, age, color, national origin, or disability. For
inquiries regarding our nondiscrimination policies, please contact the Kapiolani Community College designees:
Deneen Kawamoto, ADA Coordinator for Students Office:Ilima 107
(808) 734-9522; deneenk@hawaii.edu
UHCC offers Career and Technical Education (CTE) Programs of Study leading to Associate of Science (AS) and
Associate of Applied Science (AAS) degrees, as well as postsecondary certificates, in career fields such as arts and
communications, business, health careers, industrial and engineering technology, natural resources, and public and
human services.
For more information, visit our website at http://uhcc.hawaii.edu/programs/index.php
UHCC applies an open access policy, with program admission based upon the completion of applicable course/testing
prerequisites. The lack of English skills will not be a barrier to admission and participation in CTE programs.
Health Sciences Department